Neupro (Rotigotine) - Transdermal

What Is Neupro?

Neupro (rotigotine) is a prescription transdermal patch applied to the skin to treat Parkinson's disease and restless leg syndrome in adults. It is in a drug class known as non-ergot dopamine agonists.

Rotigotine works by improving the symptoms of Parkinson's disease, including movement control. It acts as a natural chemical in the brain called dopamine, which acts as a messenger between nerves. This helps to control movement. People with Parkinson's disease may have low dopamine, making it difficult for these nerves to communicate with one another. Neupro mimics dopamine in the brain.

Rotigotine is a 24-hour skin patch designed to deliver the drug through the skin directly into the bloodstream.

What Is Neupro Used For?

Neupro is a prescription drug used to treat both early-stage and advanced stages of Parkinson's disease. It also treats restless leg syndrome.

Since users wear a patch at all times (changing them every 24 hours), Neupro provides continuous drug delivery and keeps blood levels of the drug stable. This is associated with fewer motor fluctuations and uncontrolled muscle movements (dyskinesia) than dosing that is not continuous.

How to Use Neupro 

Neupro comes as transdermal patches that should be applied daily to the skin.

When using the patch, remember to:

• Shave hair on the application site at least three days before applying the patch to it.
• Wash your hands before and after use.
• Inspect the patch (do not use it if it is cut or does not look right).
• Apply patch to clean, dry, hairless uninjured skin once daily (every 24 hours).
• Apply at the same time each day to the shoulder, hip, upper arm, stomach, or thigh.
• Firmly press it down on your skin for 30 seconds.
• Rotate the sites of application every day.

When using the patch, do not:

• Apply to damaged, irritated, or oily skin
• Apply where the patch may rub against tight clothes. 
• Apply it to the same area more than once every 14 days. 
• Stop using it suddenly. Your healthcare provider will need to gradually lower your dose before stopping it.

Be careful not to knock your patch off. If your patch is loose, use tape only on its edges to keep it in place. However, apply a new patch to your skin if your patch falls off.  

Fold the sticky sides of the used Neupro patch to each other before tossing it. Always wash the site with water and soap every time you remove it.

This patch contains metal like aluminum. Remove the patch before a medical test called magnetic resonance imaging (MRI) to avoid skin burns. Do not expose your patch to heat sources like an electric blanket, hot tub, heating pad, hair dryers, or direct sunlight.

Storage

Keep the patches in their original pouch until application. Store in a dry place at room temperature (between 68 F and 77 F). Do not store it in the bathroom. It's OK to temporarily keep Neupro patches in cold and mildly hot temperatures (59 F to 86 F).

You can throw used patches in the household trash, but ensure they are kept out of reach of children and pets to prevent accidental ingestion.

What Are the Side Effects of Neupro?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider or pharmacist. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Tell your healthcare provider if any of these side effects or symptoms do not go away or become bothersome.

In Parkinson's disease, common side effects of Neupro include:

• Nausea and vomiting
• Drowsiness
• Application site reaction
• Loss of appetite (anorexia)
• Sleep disturbances
• Excessive sweating (hyperhidrosis)
• Vision problems
• Peripheral edema (swelling in the legs, ankles, feet, arms, or hands)
• Dyskinesia (uncontrolled movements)

Common side effects of using Neupro for restless legs syndrome include:

• Application site reaction
• Nausea
• Sleep problems
• Drowsiness
• Headache

Severe Side Effects

Contact your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Severe fatigue
• Fast or abnormal heartbeat
• Uncontrollable urges or compulsive behaviors (e.g., intense impulses to gamble, spend money, or binge eat)
• Weight gain
• Swelling (edema)
• Severe dizziness
• Trouble breathing
• Vision changes
• Severely stiff muscles or muscle pain
• Hallucinations and other psychosis-like symptoms, like confusion
• Abnormal movements
• Severe headache
• Chest pain
• Fainting
• Narcolepsy (sudden sleep attack)

Notably, the dose of this medication must be gradually decreased by a healthcare provider if you are planning on stopping treatment. Abruptly stopping it can cause withdrawal, with symptoms such as:

• Hyperpexia (high body temperature above 106.7 F)
• Confusion
• Apathy (feeling a lack of interest or emotion)
• Anxiety or depression
• Trouble sleeping
• Pain
• Fatigue
• Excessive sweating

Dosage: How Much of Neupro Should I Take?

Modifications

Your healthcare provider may make changes to your treatment plan based on the following:

• Discontinuation: If you plan to stop treatment, your healthcare provider will gradually lower your dose to reduce the risk of withdrawal.
• Pregnancy: There is not enough data to determine the safety of using Neupro during pregnancy. If you are pregnant or plan to become pregnant, work with your healthcare provider to decide whether you should continue to use this medication.
• Breastfeeding: Neupro may affect the amount of milk you produce. Talk to your healthcare provider about the best steps to take if you are breastfeeding or plan to breastfeed while using Neupro.

Missed Dose

Apply the missed patch once you remember. If you forget to change your patch, remove the old patch as soon as you remember and replace it with a new one. Replace the patch at your normal time the next day.

Overdose: What Happens If I Use Too Much Neupro? 

Overdose symptoms may be related to excessive dopamine activity and include:

• Nausea or vomiting
• Severely low blood pressure
• Involuntary movements
• Hallucinations
• Confusion
• Convulsions

Precautions

What Are Reasons I Shouldn't Take Neupro? 

Avoid taking Neupro if you are hypersensitive to rotigotine or any part of its formulation.

What Other Medications Interact With Neupro?

Certain medications interact with Neupro, causing more side effects or lowering how well the drugs work.

Neupro should not be taken with another medication class known as dopamine antagonists or drugs with dopamine antagonist properties. Due to their opposing effects on dopamine, these kinds of medications may interfere with Neupro. These may include:

• Reglan (metoclopramide)
• Molindone
• Phenothiazines
• Pimozide

Additionally, some medications may increase sedative side effects when used with Neupro. These can include:

• Opioid agonists, such as oxymorphone, OxyContin or Xtampza ER (oxycodone), and morphine
• Other central nervous system depressants, such as phenobarbital, Nayzilam (midazolam), and Ativan (lorazepam)
  

This is not a complete list of drug interactions, and others may occur. Before starting Neupro, tell your healthcare provider about all your prescription and over-the-counter (OTC) medications, vitamins, and herbal supplements.

What Medications Are Similar?

Other medications similar to Neupro include:

• Gocovri (amantadine): Gocovri is another dopamine agonist used for Parkinson's disease. It is typically used to treat dyskinesia in those receiving levodopa-based therapy or as an add-on therapy for "off" episodes. However, this medication is taken orally.
• Apokyn (apomorphine): Apokyn is used for the acute, intermittent treatment of "on" and "off" episodes in Parkinson's. It is administered through an injection.
• Mirapex (pramipexole): Like Neupro, Mirapex can be used to treat Parkinson's and restless legs syndrome. It is available in tablet form to take orally.
• Requip (ropinirole): Requip is a dopamine agonist for Parkinson's and restless leg syndrome. It is an oral medication available in tablet form.

This is a list of drugs also prescribed for Parkinson’s disease or restless leg syndrome. It is NOT a list of drugs recommended to take with Neupro. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have questions.

How Can I Stay Healthy While Taking Neupro?

Parkinson's disease is a chronic condition that begins slowly but worsens over time. Taking your medication as prescribed is the best strategy for managing symptoms. However, coping with Parkinson's disease can be more than physical; the condition can also have emotional and social impacts.

If you are experiencing anxiety or depression due to your condition, don't hesitate to reach out to a healthcare provider or therapist for help. They can help you better understand these feelings and provide coping strategies for moving forward.

Additionally, keep in communication with your healthcare provider about your symptom control. Tell them if you feel your medication isn't working well enough or if you are experiencing any new or bothersome side effects. Often, they can adjust your treatment regimen.